BILL NUMBER: AB 48	CHAPTERED  09/08/00

	CHAPTER   368
	FILED WITH SECRETARY OF STATE   SEPTEMBER 8, 2000
	APPROVED BY GOVERNOR   SEPTEMBER 7, 2000
	PASSED THE SENATE   AUGUST 31, 2000
	PASSED THE ASSEMBLY   AUGUST 31, 2000
	AMENDED IN SENATE   AUGUST 29, 2000
	AMENDED IN SENATE   AUGUST 25, 2000
	AMENDED IN SENATE   AUGUST 7, 2000
	AMENDED IN SENATE   JUNE 15, 2000
	AMENDED IN ASSEMBLY   JANUARY 24, 2000
	AMENDED IN ASSEMBLY   JANUARY 3, 2000
	AMENDED IN ASSEMBLY   MARCH 15, 1999

INTRODUCED BY   Assembly Member Cedillo
   (Coauthor:  Assembly Member Aroner)

                        DECEMBER 7, 1998

   An act to amend Section 103885 of, and to amend the heading of
Chapter 2 (commencing with Section 103875) of Part 2 of Division 102
of, the Health and Safety Code, relating to health.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 48, Cedillo.  Ken Maddy California Cancer Registry.
   Existing law requires the State Department of Health Services to
conduct a program of epidemiological assessments of the incidence of
cancer.  Pursuant to this authority, the department established the
California Cancer Registry.
   This bill would rename the registry the Ken Maddy California
Cancer Registry, and would replace the references to "tumor" in these
cancer registry provisions with "cancer."  The bill would also
expand the definition of cancer for these purposes to include primary
intracranial and central nervous system tumors occurring in
specified sites.
   This bill would incorporate additional changes in Section 103885
of the Health and Safety Code, proposed by SB 1596, to be operative
only if SB 1596 and this bill are both chaptered and become effective
January 1, 2001, and this bill is chaptered last.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:


  SECTION 1.  The heading of Chapter 2 (commencing with Section
103875) of Part 2 of Division 102 of the Health and Safety Code is
amended to read:

      CHAPTER 2.  KEN MADDY CALIFORNIA CANCER REGISTRY

  SEC. 2.  Section 103885 of the Health and Safety Code is amended to
read:
   103885.  (a) The director shall establish a statewide system for
the collection of information determining the incidence of cancer,
using population-based cancer registries modeled after the Cancer
Surveillance Program of Orange County.  As of the effective date of
this section the director shall begin phasing in the statewide cancer
reporting system.  By July 1, 1988, all county or regional
registries shall be implemented or initiated.  By July 1, 1990, the
statewide cancer reporting system shall be fully operational.  Within
60 days of the effective date of this section, the director shall
submit an implementation and funding schedule to the Legislature.
   (b) The department may designate any demographic parts of the
state as regional cancer incidence reporting areas and may establish
regional cancer registries, with the responsibility and authority to
carry out the intent of this section in designated areas.  Designated
regional registries shall provide, on a timely basis, cancer
incidence data as designated by the state department to the
department.  The department may contract with an agency, including,
but not limited to, a health systems agency, single county health
department, multicounty health department grouping, or nonprofit
professional association, representing a designated cancer reporting
region for the purposes of collecting and collating cancer incidence
data.
   (c) The director shall designate cancer as a disease required to
be reported in the state or any demographic parts of the state in
which cancer information is collected under this section.  All
cancers diagnosed or treated in the reporting area shall thereafter
be reported to the representative of the department authorized to
compile the cancer data, or any individual, agency, or organization
designated to cooperate with that representative.
   (d) (1) Any hospital or other facility providing therapy to cancer
patients within an area designated as a cancer reporting area shall
report each case of cancer to the department or the authorized
representative of the department in a format prescribed by the
department.  If the hospital or other facility fails to report in a
format prescribed by the department, the department's authorized
representative may access the information from the hospital or the
facility and report it in the appropriate format.  In these cases,
the hospital or other health facility shall reimburse the state
department or the authorized representative for its cost to access
and report the information.
   (2) Any physician and surgeon, dentist, podiatrist, or other
health care practitioner diagnosing or providing treatment for cancer
patients shall report each cancer case to the department or the
authorized representative of the department except for those cases
directly referred to a treatment facility or those previously
admitted to a treatment facility for diagnosis or treatment of that
instance of cancer.
   (e) Any hospital or other facility that is required to reimburse
the department or its authorized representative for the cost to
access and report the information pursuant to subdivision (d) shall
provide payment to the department or its authorized representative
within 60 days of the date this payment is demanded.  In the event
any hospital or other facility fails to make the payment to the
department or its authorized representative within 60 days of the
date the payment is demanded, the department or its authorized
representative may, at its discretion, assess a late fee not to
exceed 11/2 percent per month of the outstanding balance.  Further,
in the event that the department or its authorized representative
takes a legal action to recover its costs and any associated fees,
and the department or its authorized representative receives a
judgment in its favor, the hospital or other facility shall also
reimburse the department or its authorized representative for any
additional costs it incurred to pursue the legal action.  Late fees
and payments made to the department by hospitals or other facilities
pursuant to this subdivision shall be considered as reimbursements of
the additional costs incurred by the department.
   (f) All physicians and surgeons, hospitals, outpatient clinics,
nursing homes and all other facilities, individuals or agencies
providing diagnostic or treatment services to patients with cancer
shall grant to the department or the authorized representative access
to all records that would identify cases of cancer or would
establish characteristics of the cancer, treatment of the cancer, or
medical status of any identified cancer patient.  Willful failure to
grant access to those records shall be punishable by a fine of up to
five hundred dollars ($500) each day access is refused.  Any fines
collected pursuant to this subdivision shall be deposited in the
General Fund.
   (g) All information reported pursuant to this section shall be
confidential as provided in Section 100330, except that the
department and any regional cancer registry designated by the
department shall use the information to determine the sources of
malignant neoplasms and evaluate measures designed to eliminate,
alleviate, or ameliorate their effect.  The department and any
regional cancer registry designated by the department may enter into
agreements to furnish confidential information to other states'
cancer registries, federal cancer control agencies, local health
officers, or health researchers for the purposes set forth in this
subdivision if those out-of-state registries, agencies, officers, or
researchers agree in writing to maintain the confidentiality of the
information, and in the case of researchers, if they have obtained
the approval of their committee for the protection of human subjects
established in accordance with Part 46 (commencing with Section
46.101) of Title 45 of the Code of Federal Regulations.
   (h) For the purpose of this section, "cancer" means either of the
following:
   (1) All malignant neoplasms, regardless of the tissue of origin,
including malignant lymphoma, Hodgkins disease, and leukemia, but
excluding basal cell and squamous cell carcinoma of the skin.
   (2) All primary intracranial and central nervous system (CNS)
tumors occurring in the following sites, irrespective of histologic
type:  brain, meninges, spinal cord, caudae equina, cranial nerves
and other parts of the CNS, pituitary gland, pineal gland, and
craniopharyngeal duct.
   (i) Nothing in this section shall preempt the authority of
facilities or individuals, providing diagnostic or treatment services
to patients with cancer, to maintain their own facility-based cancer
registries.
   (j) It is the intent of the Legislature that the department, in
establishing a system pursuant to this section, maximize the use of
available federal funds.
  SEC. 3.  Section 103885 of the Health and Safety Code is amended to
read:
   103885.  (a) The director shall establish a statewide system for
the collection of information determining the incidence of cancer,
using population-based cancer registries modeled after the Cancer
Surveillance Program of Orange County.  As of the effective date of
this section, the director shall begin phasing in the statewide
cancer reporting system.  By July 1, 1988, all county or regional
registries shall be implemented or initiated.  By July 1, 1990, the
statewide cancer reporting system shall be fully operational.  Within
60 days of the effective date of this section, the director shall
submit an implementation and funding schedule to the Legislature.
   (b) The department may designate any demographic parts of the
state as regional cancer incidence reporting areas and may establish
regional cancer registries, with the responsibility and authority to
carry out the intent of this section in designated areas.  Designated
regional registries shall provide, on a timely basis, cancer
incidence data as designated by the state department to the
department.  The department may contract with an agency, including,
but not limited to, a health systems agency, single county health
department, multicounty health department grouping, or nonprofit
professional association, representing a designated cancer reporting
region for the purposes of collecting and collating cancer incidence
data.
   (c) The director shall designate cancer as a disease required to
be reported in the state or any demographic parts of the state in
which cancer information is collected under this section.  All
cancers diagnosed or treated in the reporting area shall thereafter
be reported to the representative of the department authorized to
compile the cancer data, or any individual, agency, or organization
designated to cooperate with that representative.
   (d) (1) Any hospital or other facility providing therapy to cancer
patients within an area designated as a cancer reporting area shall
report each case of cancer to the department or the authorized
representative of the department in a format prescribed by the
department.  If the hospital or other facility fails to report in a
format prescribed by the department, the department's authorized
representative may access the information from the hospital or the
facility and report it in the appropriate format.  In these cases,
the hospital or other health facility shall reimburse the state
department or the authorized representative for its cost to access
and report the information.
   (2) Any physician and surgeon, dentist, podiatrist, or other
health care practitioner diagnosing or providing treatment for cancer
patients shall report each cancer case to the department or the
authorized representative of the department except for those cases
directly referred to a treatment facility or those previously
admitted to a treatment facility for diagnosis or treatment of that
instance of cancer.
   (e) Any hospital or other facility that is required to reimburse
the department or its authorized representative for the cost to
access and report the information pursuant to subdivision (d) shall
provide payment to the department or its authorized representative
within 60 days of the date this payment is demanded.  In the event
any hospital or other facility fails to make the payment to the
department or its authorized representative within 60 days of the
date the payment is demanded, the department or its authorized
representative may, at its discretion, assess a late fee not to
exceed 11/2 percent per month of the outstanding balance.  Further,
in the event that the department or its authorized representative
takes a legal action to recover its costs and any associated fees,
and the department or its authorized representative receives a
judgment in its favor, the hospital or other facility shall also
reimburse the department or its authorized representative for any
additional costs it incurred to pursue the legal action.  Late fees
and payments made to the department by hospitals or other facilities
pursuant to this subdivision shall be considered as reimbursements of
the additional costs incurred by the department.
   (f) All physicians and surgeons, hospitals, outpatient clinics,
nursing homes and all other facilities, individuals or agencies
providing diagnostic or treatment services to patients with cancer
shall grant to the department or the authorized representative access
to all records that would identify cases of cancer or would
establish characteristics of the cancer, treatment of the cancer, or
medical status of any identified cancer patient.  Willful failure to
grant access to those records shall be punishable by a fine of up to
five hundred dollars ($500) each day access is refused.  Any fines
collected pursuant to this subdivision shall be deposited in the
General Fund.
   (g) (1) All data including, but not limited to, medical and
pathology records, records of health status, interviews,
questionnaires, reports, statements, notes, and memoranda collected
pursuant to this section shall be confidential.  Access shall be
limited to the department and any regional registry designated by the
department except as otherwise provided in this subdivision.
   (2) The department and any regional cancer registry designated by
the department may enter into agreements to furnish confidential data
to other states' cancer registries, federal cancer control agencies,
local health officers, or health researchers for the purposes of
determining the sources of malignant neoplasms and evaluating
measures designed to eliminate, alleviate, or ameliorate their
effect.  Before confidential data are disclosed to those out-of-state
registries, agencies, officers, or researchers, the requesting
entity shall agree in writing to maintain the confidentiality of the
information, and, in the case of researchers, shall do both of the
following:
   (A) Obtain approval of their committee for the protection of human
subjects established in accordance with Part 46 (commencing with
Section 46.101) of Title 45 of the Code of Federal Regulations.
   (B) Provide documentation to the department that demonstrates to
the department's satisfaction that the entity has established the
procedures and ability to maintain the confidentiality of the
information.
   (3) Confidential data may be disclosed to other local, state, or
federal public health or environmental agencies, or to collaborating
medical researchers, when the confidential data are necessary to
carry out the duties of the agency or researcher in the
investigation, control, or surveillance of disease, as determined by
the department.
   (4) Any disclosure authorized by this section shall include only
the information necessary for the stated purpose of the requested
disclosure and shall be made only upon written agreement that the
information will be kept confidential and will not be further
disclosed without written authorization of the department.
   (5) The furnishing of confidential data to the department or its
authorized representative or to any other cooperating individual,
agency, or organization in any study in accordance with this
subdivision shall not expose any person, agency, or entity furnishing
data to liability and shall not be considered to be the violation of
any privileged or confidential relationship.
   (6) (A) There shall be a rebuttable presumption that the necessity
for preserving the confidentiality of the data outweighs the
necessity for disclosure.  The confidential data may only be subject
to discovery or subpoena if the party seeking the disclosure rebuts
the presumption.  This presumption may only be overcome if the court
finds that the disclosure of the information will serve to protect
public health or safety.
   (B) If the court finds that the presumption has been rebutted and
the confidential data is subject to discovery or subpoena, certain
confidential information shall be redacted.  This information
includes personal names, addresses, telephone numbers, social
security numbers, personal identification numbers, insurance policy
numbers, specific places of employment and education, any other data
that identifies or accesses the participant or any friends,
employers, or associates of the participant, and any other data the
court deems appropriate.  The party requesting the data shall be
responsible for all costs associated with the production of the data,
including costs attributable to any time required to redact the
confidential information.  The party requesting the data shall
demonstrate the ability to ensure data security and confidentiality.

   (7) (A) Notwithstanding any other provision of law, any person who
violates this subdivision shall be subject to civil and criminal
penalties and other actions in accordance with Section 56.36 of the
Civil Code.
   (B) Any person who intentionally discloses confidential data to
any third party, except as authorized in this subdivision, may be
denied further access to confidential data maintained by the
department.
   (8) Nothing in this subdivision shall prohibit the publication by
the department of reports and statistical compilations relating to
the causes of malignant neoplasms or measures to eliminate,
alleviate, or ameliorate the effect of malignant neoplasms that do
not identify individual cases and sources of information or religious
affiliations.
   (h) For the purpose of this section, "cancer" means either of the
following:
   (1) All malignant neoplasms, regardless of the tissue of origin,
including malignant lymphoma, Hodgkins disease, and leukemia, but
excluding basal cell and squamous cell carcinoma of the skin.
   (2) All primary intracranial and central nervous system (CNS)
tumors occurring in the following sites, irrespective of histologic
type:  brain, meninges, spinal cord, caudae equina, cranial nerves
and other parts of the CNS, pituitary gland, pineal gland, and
craniopharyngeal duct.
   (i) Nothing in this section shall preempt the authority of
facilities or individuals, providing diagnostic or treatment services
to patients with cancer, to maintain their own facility-based cancer
registries.
   (j) It is the intent of the Legislature that the department, in
establishing a system pursuant to this section, maximize the use of
available federal funds.
  SEC. 4.  Section 3 of this bill incorporates amendments to Section
103885 of the Health and Safety Code proposed by both this bill and
SB 1596.  It shall only become operative if (1) both bills are
enacted and become effective on or before January 1, 2001, (2) each
bill amends Section 103885 of the Health and Safety Code, and (3)
this bill is enacted after SB 1596, in which case Section 2 of this
bill shall not become operative.
